Cervical Stenosis

Cervical stenosis refers to the pathological narrowing of the spinal canal in the cervical spine (C1-C7 vertebrae). This constriction can compress both the spinal cord (myelopathy) and nerve roots (radiculopathy), potentially causing significant neurological deficits.

Primary Etiology

  • Degenerative changes (most common):

    • Spondylosis (spinal osteoarthritis)

    • Hypertrophic facet joints

    • Ligamentum flavum thickening

  • Congenital factors:

    • Naturally narrow spinal canal

    • Genetic predisposition

  • Other causes:

    • Herniated discs

    • Spinal trauma

    • Post-surgical changes

    • Ossification of posterior longitudinal ligament (OPLL)

Clinical Presentation

Neurological Symptoms:

  • Radicular symptoms (nerve root compression):

    • Sharp, radiating arm pain

    • Paresthesia in dermatomal patterns

    • Muscle weakness in specific myotomes

  • Myelopathic symptoms (cord compression):

    • Hand clumsiness (loss of fine motor skills)

    • Gait disturbances

    • Hyperreflexia

    • Potential bowel/bladder dysfunction (late stage)

Pain Characteristics:

  • Chronic neck pain/stiffness

  • Headaches (occipital region)

  • Aggravation with neck extension

Diagnostic Workup

  1. Imaging:

    • MRI (gold standard for soft tissue evaluation)

    • CT myelography (for surgical planning)

    • Dynamic X-rays (assessing instability)

  2. Electrodiagnostics:

    • EMG/NCS (differential diagnosis)

  3. Clinical Assessment:

    • Spurling’s test

    • Hoffman’s sign

    • Lhermitte’s phenomenon

Management Strategies

Conservative Treatment:

  • Physical therapy (cervical stabilization)

  • Medications:

    • NSAIDs

    • Neuropathic agents (gabapentin/pregabalin)

    • Epidural steroid injections

  • Cervical collar (limited use)

Surgical Indications:

  • Progressive neurological deficits

  • Refractory pain

  • Myelopathic symptoms

  • Significant cord compression on imaging

Surgical Options

  • Anterior Approach:

    • ACDF (anterior cervical discectomy & fusion)

    • Corpectomy (for multi-level involvement)

  • Posterior Approach:

    • Laminectomy

    • Laminoplasty (motion-preserving)

  • Combined Approaches (for complex cases)

Prognosis & Outcomes

  • Early intervention improves outcomes

  • 70-80% success rate with appropriate surgery

  • Physical therapy crucial for post-op recovery

  • Regular follow-up for adjacent segment disease

Preventive Measures

  • Maintain neck muscle strength

  • Ergonomic workplace adjustments

  • Regular physical activity

  • Smoking cessation (accelerates degeneration)

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